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Getting Treatment

If you are a patient with atopic eczema and you would like to use The Combined Approach there are two main options, the self-help programme, and the clinic-based programme.

The self-help programme

Self-help is an important component of The Combined Approach to atopic eczema: it is not a passive treatment. Active patient participation is key to its effectiveness, unless the patient is very young.  With the self-help programme, how much professional input is required will vary from person to person. At least some will be necessary for everyone, as the programme involves medical treatment.

The self-help version of The Combined Approach, "The Eczema Solution" by Sue Armstrong-Brown, was written after she had successfully followed the treatment programme as an out-patient at Chelsea & Westminster Hospital, London. She was delighted by the results and wanted as many people as possible to benefit from the same treatment approach. The self-help programme in her book has the same structure as the clinic-based programme.

First there is a week recommended for base-line counting and analysis of scratching, before starting four weeks for the main treatment phase. Almost all that is needed is her book, and a hand tally counter. Counters can be purchased from any good High Street stationery store, or online - see Shopping Links. Otherwise it is only necessary to organize some input from a primary care team. Ways of approaching a family doctor about this are covered in her book.

However you will also find it useful to read here the article  "Behavioural Dermatology - The combined approach to atopic eczema", and to watch here "Live without Eczema" - The Video. 

Although Sue's book emphasizes self-help, the programme aims to change behaviour and the more that can be built-in to achieve this change, the more successful will be the outcome. If there are others around - family, or friends - to discuss the project with, and get support from, so much the better. Tell them about it, show them what you are doing, and explain how they can help. Also you can read how others have helped themselves: see  anon, and Katie.

Please let us know about your experience using the self-help programme. Keep in touch with us and give us an update as time goes by. Come back to this site and see how others are getting on. Sharing experience in this way is very important.

The clinic-based programme

The self-help approach is based on the successful clinic-based format, which in turn is based on the formula originally devised by Dr Peter Norèn and his colleagues in Sweden. It was the publication of their research results that led to the introduction of The Combined Approach at Westminster Hospital in 1989, and later at Chelsea & Westminster Hospital, London. Since then psychologists, dermatologists, psychiatrists, family doctors and nurse practitioners have easily learnt how to use The Combined Approach. Primary Care is ideal for The Combined Approach, with the hospital clinic perhaps reserved for training, and for complex cases.

The clinic-based programme is described here in detail in "Atopic Skin Disease - A Manual for Practitioners". The programme usually involves you working with a nurse or a medical practitioner, but you will be doing most of the work.

At present the clinic-based treatment programme is not widely available. In the UK the map here gives you some idea - we will update this from time to time: let us know if you are offering the treatment where you are and you would like us to know. Equally, please let us know if you get the treatment where you are, so we can let others know. 

If you use the clinic-based treatment programme you will find it useful to refer to all the resources available here, especially perhaps the Reinforcement Tips. If you particularly like an article, please hit the Add to Favorites   symbol at top right - and then use the DISQUS comment panel at the end of the article to share your thoughts.  It is important that your experience of atopic eczema, its conventional treatment, and the effectiveness of The Combined Approach is read about and discussed with others. Practitioners especially can learn as much from you as they can from colleagues, Journals and Textbooks.

After completing the clinic-based programme, please keep in touch with us here, and let us know about your progress. Sharing experience in this way is a very useful way of keeping on track.

Dr Christopher Bridgett


Chronic atopic eczema and readiness for habit reversal

Teledermatology, habit reversal and atopic eczema

The Combined Approach to atopic eczema - A Series of Steps

Success with habit reversal for chronic atopic eczema

1989-2019 Habit reversal for atopic eczema in the UK

Isaac talks to DrB about online eczema advice and apps

Ida Bafende talks to DrB about habit reversal for childhood atopic eczema

From the clinic: Before we start habit reversal

Anon talks to DrB about Weeks 4 to 6 with The Eczema Solution and Twitter

Treating chronic eczema: The Healing Curve

Anon talks to DrB about Weeks 2 and 3 with The Eczema Solution and Twitter

Anon talks to DrB about using Twitter with The Eczema Solution

Key elements in habit reversal for chronic atopic eczema

Katie talks to DrB

Psychodermatology: the overlap between psychiatry and dermatology